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Max New York Life Insurance Company Limited & Another v/s Sukhada Middya

    S.C. Case No. 191/A of 2007

    Decided On, 16 May 2008

    At, West Bengal State Consumer Disputes Redressal Commission Kolkata

    By, MEMBER

    For the Appellants: D. Basu Mullick, Advocate. For the Respondent: Sekhar Kanti Das, Advocate.

Judgment Text

S. Majumder, Member:

1. This appeal has arisen against the judgment passed by the District Forum, Paschim Medinipur, on 3.4.2007, in its Case No. 29/2006, wherein the learned Forum below has allowed the complaint and directed the OP to pay a sum of Rs. 1,00,000 and other benefits as permissible in terms of the policy document together with the amount of interest @ 9% p.a. on Rs. 1,00,000 within 30 days from the date of communication of the judgment to the Complainant, failing which the above mentioned amount would carry interest @12% p.a. for the default period.

2. The brief facts of the case of the Complainant before the Forum below were that Sri Anil Kumar Middya, deceased husband of the Complainant took a Life Insurance Policy under the plan of ‘Life Gain Plus’ with the coverage of a sum of Rs. 1,00,000 from the OP. He submitted the proposal form on 5.1.2004 and the policy was issued on 1.3.2004. The insured died on 4.1.2005. Being nominee in respect of the policy in question the Complainant lodged the death claim before the Insurance Company by filing all the relevant and necessary papers. The OP repudiated the claim on the ground of suppression of material fact by the insured regarding his physical condition at the time of taking the policy. Finding no other alternative the complainant filed the complaint before the Forum below praying for direction upon the OP to pay her the entire assured sum of Rs. 1,00,000 and all other benefits as per terms and conditions of the policy.

3. The OP took the plea before the Forum below by filing written objection that the Complainant did not disclose that he was suffering from hypertension at the time of taking out the policy in the proposal form and for this reason they repudiated her claim and there was no deficiency in service on their part.

4. Being dissatisfied with the above-mentioned judgment the OP No. 1-Appellant has preferred this present appeal before this Commission contending that the deceased life assured had never disclosed in the proposal form that he was suffering from Hypertension disease since 1998; he submitted the proposal form on 5.1.2004 and took the policy from the Insurance Company on 1.3.2004. Therefore, by withholding this material information by the life assured induced the insurer to enter into a contract and accept the risk and thereby practiced fraud. For such reason, the insurer rightly repudiated the claim for deliberate suppression of material information and such repudiation does not amount to deficiency in service. According to the Appellant, the judgment passed by the District Forum is erroneous, illegal, unjust and liable to be set aside and prayed for allowing the present appeal.

5. On careful perusal of the record and various documents, it is seen by us that it is an admitted fact that the deceased husband of the present respondent-complainant took the Life Insurance Policy for a sum of Rs. 1,00,000. On 5.1.2004, he submitted the proposal form and the present Appellant issued the policy on 1.3.2004. After the death of her husband the present respondent-complainant, being the nominee of the said policy submitted the death claim form along with the relevant documents and papers to the Appellant-Company. However, the said claim was repudiated on the ground of suppression of material facts. In this context, we have perused the record i.e. ‘Attending Physician’s Statement in Form-C’ the immediate cause of death was ‘Cardio Respiratory Failure’ and against the question No. 4(b) ‘How long had he been suffering from the disease before death’? The answer was written ‘Sudden’. Against the question No. 6 in the same document, the said attending physician’s statement was that the said physician treated the deceased approximately in the year of 1998 and he diagnosed that the deceased was suffering from hypertension. However, in support of such contention of the said physician, the Appellant has failed to adduce any cogent evidence. There is no prescription or certificate of the said physician, Dr. S.K. Maity which helps us to come to the decision that the deceased was actually under the treatment of the said doctor in 1998, who opined that the deceased was suffering from hypertension. Though the Appellant has filed a certificate of Dr. S.K. Maity (Annexure-XII), the date of issuance of that certificate is 1.1.2006, while the husband of the Complainant-Respondent died, on 4.1.2005. Therefore, this certificate is not at all relevant with the present case/appeal. Moreover, the Appellant on affidavit has not filed this document and for this reason, it has no evidentiary value for adjudication of the appeal. It is curious to us that in the said document (Form-C) against the question No. 4(f) that ‘was there any contributory cause of death or any chronic ailments?’ the answer was written ‘No’ by the said Dr. S.K. Maity. Therefore, it is clear to us that the deceased was not suffering from any chronic disease and there was no contributory cause of death, the cause of death has been occurred suddenly. In this context we may refer to a judgment passed by the Hon’ble National Commission, reported in IV (2007) CPJ 182 (NC)=(2003) 1 WBLR (CPNC) 592, New India Assurance Co. Ltd. v. Harbans Singh. The case was that after taking a Medi-claim Policy on 11.5.1996 the Complainant got admitted in a Hospital on 31.5.1996 after a heart attack and ultimately underwent a Heart Bye-pass Surgery. He preferred a medical claim, which was turned down by the Insurance Company. Being aggrieved, the Complainant moved the District Forum, which allowed the claim. The appeal before the State Commission failed. Hence, the petitioner Insurance Company moved the National Commission by revision. The Hon’ble National Commission dismissed the revision application. In the instant case/appeal, the Appellant could not file any previous prescription of any doctor prior to taking out the Insurance Policy that the Respondent bore any symptoms or sickness relating to his disease. Therefore, it cannot be said that the ailment was pre-existing before taking out the policy. Moreover, no body knows when she/he w

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ill suffer from any kind of sudden pain or disease requiring treatment/operation. 6. Going by the foregoing discussion, we deem it appropriate to pass the following order: In view of our findings aforementioned and keeping in view the fact that the District Forum cannot be said to have acted without jurisdiction, we are of the opinion that no case has been made out for interference with the impugned judgment. The Appeal be accordingly dismissed on contest. However, in the facts and circumstances of the case, there shall be no order as to cost. The appeal be disposed of accordingly. The judgment passed by the District Forum is hereby affirmed. Appeal dismissed.